Poverty and the healthcare professional

November 15, 2016

A summary of the effects of socioeconomic status, showing all health care professionals the daunting task they have in tackling poverty.

The sister profession of public health continues to provide dental hygienists with opportunities for professional growth and information regarding the behaviors associated with poor health. Most pertinent of all these includes poverty and its lingering effects on the health of Americans.

What is poverty?

The United States measures poverty by an outdated standard developed in the 1960s.

Poverty line:

One person: $12, 000

Two people: $15, 000

Three people: $19,000

Four people: $24,000

47 million Americans (this includes 15.5 million children) live in a cycle of poverty and poor health that is difficult to break. 105 million live close to poverty, with incomes less than two times that of their poverty thresholds.

As of 2014, the national poverty rate was at 14.8 percent with clear distinctions seen between whites and people of color: 26.2 percent of African-Americans and 23.6 percent of Latinos are poor, compared with 10.1 percent of whites. Poverty now, as always, is not equally distributed among racial groups.

Those who live in poverty are at an increased risk of getting ill because of poor nutrition and stress-the harsh realities of which may make risking their health a necessity in order to keep the family safe. Poor health, in turn, increases the chances of poverty, reducing a family’s work productivity and often necessitates the use of desperate measures such as the selling of assets in order to keep the family safe.

What are the social determinants of health?

Poverty is just a part of the problem. Poverty contributes to a greater phenomenon, socioeconomic status (SES), which more accurately paints a picture of the effects of poverty. SES includes not just material wealth (or lack of material wealth) but a multitude of different social, economic and cultural factors including education and social prestige. The US Department of Health and Human Services recognizes that SES affects a person’s health and has highlighted the importance of addressing these Social Determinants of health which include:

Where you live: Is there clean and safe water and air? Is housing safe and not overcrowded? Is there good sanitation? What are levels of crime like? How safe are roads? Are there jobs with decent working conditions?

Genetics: Have you inherited a greater likelihood of certain illnesses?

Nutrition: Is there access to healthy food? Is healthy food being regularly consumed?

Education: Going to school improves many health outcomes.

Relationships with friends and family: Strong support networks improve all health outcomes.

Social status and social exclusion: People who are excluded or denied access to social forums experience poorer health.

Access to and use of health services: Are services and providers available nearby?

Personal behaviors: Includes exercise, eating habits and social habits such as smoking/excessive drinking of alcohol.

Up next: The effects of low SES and your role

SES and the brain

Parental socioeconomic status has been shown to affect cognitive functions in children. These children whose parents experience low SES show gradual declines in mental, motor and socioemotional development compared to children whose parents have higher levels of SES.

One of the primary reasons for the decline is due to the effects of chronic stress. Repeated exposures to adverse childhood experiences, or ACEs, mold a child’s developing brain, particularly in the prefrontal cortex, which is in charge of executive function and differentiating between good and bad, and the hippocampus, which handles memories and learning. Children who experience ACEs are not ready for kindergarten, so they fall behind quickly and have difficulties learning to read which impairs working memory.

Chronic stress can interact with other toxins like air pollution, or genetic predispositions with consequences including cognitive deficits and emotional disorders. Kids who grow up with higher levels of violence as a backdrop in their lives, based on MRI scans, have weaker real-time neural connections and interaction in parts of the brain involved in awareness, judgment, and ethical and emotional processing. As they age, these children exhibit impaired brain function and emotional problems as adults. In short, learning, behavioral, mental health and physical health problems are seen at higher rates among those who were raised in poverty. These deficiencies persist into adulthood.

Thankfully, because the brain is very adaptable, the effects of stress can be combatted through nurturing relationships and consistent feelings of safety. Additionally, some research on poverty alleviation (i.e. cash transfer programs) has supported the reversal of the neurobiological effect of poverty.

We cannot improve the oral health of Americans without first resolving the greater, more pressing issue of poverty. All oral health care providers adhere to a Code of Ethics which recognizes our responsibility in sharing our knowledge and skills in order to improve health. In every way, let’s try to acknowledge the challenges a large portion of Americans face, provide them with resources and professional care, promote healthy lifestyles in our own communities and advocate legislatively for programs with proven records of effectiveness.

References

http://www.nytimes.com/2012/07/29/opinion/sunday/why-cant-we-end-poverty-in-america.html

www.youtube.com/watch?v=KdTiPGVZNes

www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

journals.plos.org/plosone/article?id=10.1371/journal.pone.0080954

http://www.citylab.com/housing/2013/10/how-crummy-run-down-housing-harms-children-who-live-it/7345/

Income, Poverty, and Health Insurance Coverage in the United States: 2014, U.S. Census Bureau; Income and Poverty in the United States: 2014, U.S. Census Bureau

Kim et al. Effects of childhood poverty and chronic stress on emotion regulatory brain function in adulthood. PNAS (2013). 110 (46); 18442-18447.